In the past 60 years, several different
procedures have attempted to achieve a postoperative neophallus that is as
aesthetic and as functional as possible after penile amputation or sex
reassignment. Recently, with improvements in free tissue transfer and
microvascular technique, many free flap procedures have been developed with
the goal of an aesthetically acceptable neophallus of adequate bulk that
enables urination in a standing position and sexual intercourse, with
minimal functional and aesthetic donor-site defects.
Most authors currently agree that the
method of choice for penile reconstruction is microsurgical free tissue
transfer, although it does not always fulfill all of the aforementioned
goals in a predictable manner. In fact, complete urethroplasty, penile
rigidity, and donor-site disfigurement remain challenges, thus making this
operation one of the most difficult in plastic surgery. The vascular anatomy
of the lateral circumflex femoral artery, which we studied in 1991 with the
anatomic dissection of 27 cadavers, gave us the idea to use a long tensor
fasciae latae neurovascular island flap as a donor source for
neophalloplasty. Grounds for the procedure and its surgical planning have
been carefully evaluated with 10 additional fresh cadaver dissections.
Since 1991, we have performed five
neophalloplasties using this procedure; all patients were female-to-male
transsexuals. In four cases, the healing was uneventful; in one case, there
was a marginal necrosis of the flap because of poor venous drainage,
probably from a twisting of the pedicle. The island tensor fasciae latae
provides a safe and sensate flap for phalloplastic procedure and leaves a
less conspicuous donor scar.
Citation:
Plast Reconstr Surg 2000 May;105(6):1990-6 an article published on the
Internet by PubMed <http://www.ncbi.nlm.nih.gov/>
